Unusual manifestation of eosinophilic meningitis.

Eosinophilia of the cerebrospinal fluid (CSF) can be found in various parasitic infestations of the central nervous system. Angiostrongylus canto­ nensis is the most common etiologic agent of eosi­ nophilic meningitis in Thailand and its interme­ diate host is Pila snails (Punyagupta et ai, 1970). Humans are infected by this parasite after ingesting raw Pila snails. The common presenting symptoms of eosinophilic meningitis are severe headache, neck stiffness, nausea and vomitiing (Punyagupta et ai, 1975; Kuberski and Wallace, 1979; Pana­ monta, 1985; Chotmongkol, 1986; litpimolmard et ai, 1991). High fever (temperature> 38°C) and CSF abnormalities such as marked elevation of total leukocyte count and protein content, or low sugar profile rarely occur. We report a case of eosinophilic meningitis, probably caused by A. cantonensis, which had this rare presentation.